MEDICARE: EYE CENTER GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780665059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CENTER GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 472
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47308-0472
Country	:	US
Telephone Number	:	765-286-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 TROJAN LN
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-2966
Country	:	US
Telephone Number	:	765-521-0675
Fax Number	:	765-593-0703

Authorized Official
Title or Position	:	PART OWNER
Name	:	DR. JEFFREY S RAPKIN
Credential	:	MD
Telephone Number	:	765-286-8888

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	02/22/2008

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Directions to “EYE CENTER GROUP LLC ” Practice Location

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